About the Drug Formulary
A drug formulary is a complete list of prescription drugs that are approved for coverage by Oxford Medicare Advantage. For your prescription drugs to be covered the drugs must be included in the formulary and the prescriptions must be filled at a "contracted" or "network" pharmacy. Use the formulary with your doctor's help to choose the best drugs for you and to help lower your costs.

Generic Drugs
Oxford Medicare Advantage covers both brand name and generic drugs. A generic drug has the same active-ingredient formula as a brand name drug. Generic drugs usually cost less than brand name drugs and are approved by the Food and Drug Administration (FDA). You should consult with your doctor to determine whether you can lower your prescription drug costs by using generic drugs instead of more expensive brand name drugs.

How to use the Formulary
There are two ways to find your prescription drug within the formulary. The drugs are grouped into categories depending on the health condition they treat. For example, if you want to find drugs used to treat a heart condition, you would turn to the category listing and look for "Heart and Circulation."

If you are not sure what category to look under, you should look for your drug in the Index. The Index provides an alphabetical list of all of the drugs included in the drug formulary.

If your drug is not included in the complete formulary, you should talk with your doctor about prescribing a covered drug if it is an acceptable alternative.

Your Copayment
The drug formulary includes four tiers described below. The copayment you pay depends on the tier (or coverage level) assigned to your prescription drug. The Summary of Benefits lists the copayments that apply to each tier. If you qualify for
extra help in paying for your prescription drugs, your copayments may be different than those described here. Please contact Customer Service to find out what your costs are in this situation.

Tier 1: Most generic prescription drugs are included in this tier. Generic drugs usually cost less than brand name drugs. Drugs in Tier 1 have the lowest copayment.

Tier 2: This tier includes brand name prescription drugs. Drugs are included in Tier 2 because they offer clinical advantages and/or lower prices than Tier 3 drugs. Drugs in Tier 2 have a medium copayment.

Tier 3: Drugs in Tier 3 are covered by this plan, but have a higher copayment. If you are taking a Tier 3 drug, ask your doctor if a Tier 1 or Tier 2 drug could be a possible alternative.

Specialty Tier (SP): Unique, very high-cost drugs are included in this tier. These drugs require a fair level of cost-sharing between you and the plan (percentage copayment).

Oxford Medicare Advantage covers all medical supplies needed for the injection of insulin on Tier 1, including syringes, needles, alcohol, swabs, and gauze.

The formulary may change during the year. The list of drugs that are included in the plan and tier category may change. If you are affected by the change to the formulary, you will receive written notice at least 60 days before the change is effective. For updated information about the drugs included in the formulary, visit the web site or call our Customer Service Department.